Basic Information
| Provider Information | |||||||||
| NPI: | 1760688519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIAS | ||||||||
| FirstName: | IRENE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | STE 145 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302940 | ||||||||
| FaxNumber: | 2535302970 | ||||||||
| Practice Location | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | STE 145 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302940 | ||||||||
| FaxNumber: | 2535302970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OP60460467 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 327409 | 01 | WA | STATE L&I | OTHER |